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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date �,Z L� �— OFFICE USE ONLY <br /> To: San Joaquin County JOB# oo S Z REF# <br /> Department of Public Works APN _ CR# <br /> EXP.DATE �!—J —/S <br /> Pacific Gas & Electric <br /> VALID <br /> ET Z 6 (�S TO DRIVEWAYS: <br /> P.O. BOX 930 AREA QUAD V ^ <br /> TYPE <br /> STOCKTON, CA 95201 FORMS S I,,/�✓ 22� <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> California supplement <br /> PM -�)L 11 55p'.'71 <br /> Notif. <br /> The ndersigned hereby applies for ermission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the side of 1-�1 �11"..' approximately aft— # <br /> ofr by performing the following work(descri tion of work): <br /> r-,MACQ,&-,C,J U-brV, -111V rz�r �- i-CA <br /> Work will commence on or about u3 for approximately to days. <br /> I,the undersigned, certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> Signature of Applicant-Title Date <br /> E:IP HMASTER.PMFNCROACHMENT PERMIT APPLICATION.DOC (01108) <br /> ReturnPermits to: <br /> CCD <br /> t P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />